Diagnosis of pediatric gastric, small-bowel and colonic volvulus

Abstract

Digestive volvulus affects the stomach, small bowel and mobile segments of the colon and often has a developmental cause. Reference radiologic examinations include upper gastrointestinal contrast series for gastric volvulus, possibly with ultrasonography for small-bowel volvulus, and contrast enema for colonic volvulus. Treatment is usually surgical. This pictorial essay describes the embryological development and discusses the clinical and radiologic presentation of volvulus, depending on location, and details the appropriate radiologic examinations.

Colonoscopic decompression of childhood sigmoid and cecal volvulus

“…From the three reported cases here, two were males. While small intestine rotation is a common phenomenon in children, large intestine twisting in children is rarely caused by colonic volvulus (6,9). Similar to adults, malrotation in children is also most commonly observed in the sigmoid colon, while in cecal volvulus, it is seen in 20%-40% of cases (3).…”

“…While rotation in the cecum may be triggered by long-term distention or constipation or surgical procedures, sigmoid volvulus generally results from an unstable/motile sigmoid colon. In 18% of children with sigmoid volvulus, the condition may be detected in the context of Hirschsprung disease (9). Colonic volvulus is life-threatening condition in which a twisted portion of the colon may result in severe ischemia, perforation, and necrosis.…”

“…Specific signs that are highly indicative of cecum, sigmoid, or transverse colon volvulus (i.e., kidney been sign, coffee bean sign, and inverted coffee been sign) can be seen in abdominal X-rays (13). Although the classical coffee bean sign on performing X-ray imaging is a specific diagnostic feature, only 30% of patients may have this sign (9). In a survey of 19 patients with colonic volvulus, only two had the coffee bean sign in their abdominal X-rays (8).…”

“…Despite the fact that surgical intervention is a curative approach for colonic volvulus, this procedure is invasive. Surgical intervention is generally considered for transverse colon volvulus (9). On the other hand, colonoscopy may be associated with a high risk of recurrence (11).…”

Abdominal Distension in an Eleven-Month-Old Male

“…However, given that symptoms are often nonspecific, a high index of suspicion must be maintained in ill-appearing children with abdominal complaints [1,2]. When there is concern for gastric volvulus, acute diagnostic modalities include an acute abdominal film, chest x-ray, upper GI series with contrast, and abdominal ultrasound [3,4]. A nasogastric tube should be placed to decompress the proximal obstruction created by the closed loop.…”